title: Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps.
abstract: BACKGROUND
  Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended.
  
  
  METHODS
  A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics.
  
  
  RESULTS
  Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors.
  
  
  CONCLUSIONS
  Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance.
authors.affiliation: Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX, USA; The Children's Memorial Hermann Hospital, Houston, TX, USA.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Hawkins
authors.forename: Shauna M
authors.initials: SM
authors.lastname: Levy
authors.forename: Casey E
authors.initials: CE
authors.lastname: Senter
authors.forename: Jane Y
authors.initials: JY
authors.lastname: Zhao
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Doody
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000706:statistics & numerical data*; D002983:Clinical Competence; D004282:Documentation; D004305:Dose-Response Relationship, Drug; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D017410:Practice Guidelines as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control; D013781:Texas
chemical_list: D000900:Anti-Bacterial Agents
keywords: Adherence; Antibiotic prophylaxis; Compliance; Implementation fidelity; SCIP; Surgical site infection